Snowball fight - an unusual cause of spleen injury

Summary

Our case describes an innocuous snowball fight arising into a life-threatening condition. Patient with progressive left-sided abdominal pain was brought by ambulance to the hospital. According to history he was not aware of any trauma, just a snowball fight with his wife 5 days ago. Clinical examination finding was: hint of peritoneal irritation, Kehr´s sign and left-subchondrium palpation pain. The spleen trauma suspicion was high. After clinical examination an ultrasound examination was performed, revealing inhomogeneous structure of the spleen surrounded by hypoechoic collection and free fluid in the pelvic area. The patient added information about the possible trauma - it was not an ordinary snowball, but a piece of ice about 40cm. Computed tomography was subsequently performed, with the findings: spleen laceration, intraparenchymal hematoma, subcapsular hematoma and haemoperitoneum. The patient was urgently transferred to the operating room and splenectomy was performed. The intraoperatively findings corresponded to the imaging methods and the amount of blood and clots in the abdominal cavity was approximately 1000ml. The post-operative condition and rehabilitation was uncomplicated and one week after splenectomy the patient was released from hospital, with no subjective difficulties. This case shows spleen susceptibility to injury, even in trauma which can be considered not so severe at the first sight. It is important to correlate clinical and imaging methods findings and check the patient´s condition over a longer period, if necessary.

Keywords:
blunt injury – trauma of spleen – haematoma of the spleen – snowball – splenectomy